Saturday, April 8, 2017

Anais Martinez is on the hunt in Mexico City's Merced Market, a sprawling covered bazaar brimming with delicacies. "So this is the deep-fried tamale!" she says with delight, as if she'd just found a fine mushroom specimen deep in a forest.

The prized tamales are wrapped in corn husks and piled next to a bubbling cauldron of oil.

"It's just like a corn dough patty mixed with lard, put in a corn husk or banana leaf, steamed and then deep fried," says Martinez of this traditional Mexican breakfast. "And then after you fry it, you can put it inside a bun and make a torta [sandwich] out of it. So it's just like carbs and carbs and fat and fat. But it's actually really good."

And it only costs 10 pesos — roughly 50 cents.

Martinez is a designer in Mexico City. She studied gastronomy here and now moonlights for a company called Eat Mexico giving street food tours.

Deeper in the market there's an area packed with taco stalls. Customers stand at the counters or sit on wobbly plastic stools. The young cooks fry, flip and chop various meats into tortillas. They pound strips of flank steak out on wooden cutting boards. Piles of red chorizo sausage simmer in shallow pools of oil. Yellow slabs of tripe hang from meat hooks.

We've just come to one of Martinez's favorite taco stands. Its specialty is pork tacos served with french fried potatoes piled on top.

"The pork is really thinly sliced, rubbed with chiles and spices and then they fry it," Martinez says as the meat sizzles on a long steel griddle in front of her. "Also, really good."

Rich, fatty street food like this is available all over Mexico — at bus stops, at schools and on street corners. And it's affordable to the masses. A heaping plate of Martinez's favorite pork tacos costs less than a dollar.

All that cheap food — in a country where incomes are rising — is contributing to Mexico's massive diabetes epidemic.

Diabetes is now the leading cause of death in Mexico according to the World Health Organization. The disease takes an estimated 80,000 lives each year. Nearly 14 percent of adults in this country of 120 million suffer from the disease — one of the highest rates of diabetes in the world. And it's all happened over the last few decades.

Tuesday, April 4, 2017

VideoCasts enable participants to view Division, Institute, and Branch town halls, conferences and seminars remotely while responding to questions during the session. Include a one-way broadcast of the presentation with high-quality video and/or slides to reach a larger target audience.

The first time I got pregnant, I was a comparatively young mother, for my demographic: I was 25, in medical school, surrounded by classmates who, for the most part, were not reproducing yet. By the third pregnancy, 11 years later, I was over 35, which classified me, in the obstetric terminology I had learned in medical school, as an "elderly multigravida," that is, someone who was having a child but not her first child, after 35. (If it was your first child, you were an "elderly primigravida," or "elderly primip" for short — even as a medical student, I had a strong sense that no woman had invented this terminology.)

So by certain standards, I have experience as both a somewhat younger mother and a somewhat older mother, though not at the extremes in either direction.

National Vital Statistics Reports data released in January showed that in the United States, birthrates shifted in 2015: The birthrate for teenagers dropped to 22.3 births per 1,000 females ages 15 to 19 that year, a record low for the nation. And for women 30 through 44, the birthrates were the highest they have been since the baby boom era of the 1960s.

And as birthrates shift toward somewhat older mothers, researchers continue to look at what that says, both about who is getting pregnant when, and how that is associated with how their children do, especially when it comes to cognitive outcomes. (There's also been some interesting research recently on paternal age, but these studies focused on the mothers.)

About 6.4 million children in the United States have been given diagnoses of attention deficit hyperactivity disorder (A.D.H.D.). But the condition — characterized by impulsiveness and difficulty sitting still and paying attention — is also being recognized more in adults. The challenges faced by those with A.D.H.D. are daunting and deeply personal. Here, in their own words, are the stories of adults and children coping with A.D.H.D.

Sunday, April 2, 2017

In an exclusive excerpt from Deadliest Enemy, a new book on the threat of emerging diseases, epidemiologist Dr. Michael T. Osterholm and writer Mark Olshaker present a fictional tabletop-­like scenario involving an influenza pandemic in today's world, with the virulence of 1918's H1N1 strain, which resulted in the deaths of 50 million to 100 million people. This scenario has been reviewed by colleagues in public health preparedness and business continuity planning. There is general agreement that it is realistic and possible. Keep that in mind as you imagine yourself and your family living through it.

One evening last November, a fifty-four-year-old woman from the Bronx arrived at the emergency room at Columbia University's medical center with a grinding headache. Her vision had become blurry, she told the E.R. doctors, and her left hand felt numb and weak. The doctors examined her and ordered a CT scan of her head.

A few months later, on a morning this January, a team of four radiologists-in-training huddled in front of a computer in a third-floor room of the hospital. The room was windowless and dark, aside from the light from the screen, which looked as if it had been filtered through seawater. The residents filled a cubicle, and Angela Lignelli-Dipple, the chief of neuroradiology at Columbia, stood behind them with a pencil and pad. She was training them to read CT scans.

"It's easy to diagnose a stroke once the brain is dead and gray," she said. "The trick is to diagnose the stroke before too many nerve cells begin to die." Strokes are usually caused by blockages or bleeds, and a neuroradiologist has about a forty-five-minute window to make a diagnosis, so that doctors might be able to intervene—to dissolve a growing clot, say. "Imagine you are in the E.R.," Lignelli-Dipple continued, raising the ante. "Every minute that passes, some part of the brain is dying. Time lost is brain lost."

He is breathing better and the doctors say his lungs will recover, but he can't remember his appointments or where he put his keys.

It has been months since the surgery and the scars are fading, yet she still wakes almost nightly to the sound of phantom alarms.

Those are the sorts of stories I heard one morning at a support group for patients who had survived a critical illness and their family members. It seems simple — a few doctors, a social worker, a psychiatrist, former patients and their husbands and wives, a conference room, pastries, coffee. In a way it was. But this was the first time that many of these men and women had been asked to talk about their struggles after critical illness with those who'd shared similar experiences.

And it was among the first times that I — then a doctor in my final year of critical care training — had heard directly from them about their lives after the I.C.U.